‘United in Health D10’ to crush the coronavirus

by United in Health

This weekend, teams of volunteers from UCSF, Rafiki Coalition for Health and Wellness, the San Francisco Human Rights Commission and other community partners will be out in the Bayview, Sunnydale and Visitacion Valley to offer free testing for COVID-19 for people who live and work in the two neighborhoods. 

Testing will be available to all who live, work, play or pray in San Francisco. For the Bayview, tests will take place THIS WEEKEND on Saturday and Sunday, May 30 and 31, 2020, from 9:00 a.m. to 5:00 p.m. at Havard Early Education School, 1520 Oakdale Ave., just east of Third Street.

Testing for Sunnydale and Visitacion Valley will take place this coming Monday and Tuesday, June 1 and 2, 2020, from 9:00 a.m. to 7:00 p.m. at Herz Playground, 1701 Visitacion Ave.

Dr. Kim Rhoads of UCSF and Dr. Monique LeSarre of Rafiki Coalition for Health and Wellness talk about why they decided to launch this effort and how it can help to stop the spread of the coronavirus that causes COVID-19.

Q: How did this testing effort get started?

Dr. Monique LeSarre: Kim called, and anything she’s doing, I’m supportive of. We try to see how we can connect and build for the community. Dr. Rhoads and I both share a really strong belief in equity and a strong belief in supporting our community. Kim said, “Let’s do this in the Rafiki parking lot.” So, I started to socialize it around, and people were like, “Yeah, that would be great.” 

In our community, we are being underdiagnosed and under-tested. I was seeing all the reports across the country for African Americans, and we were doing extremely poorly. We were seeing reports of a severe death toll from COVID-19 for African Americans in New York, Chicago, Michigan, Ohio and Los Angeles, too. 

We were very concerned, because there are certain things that already make us a vulnerable community, including limited access to health care, transportation and a full-service grocery store – the impact of social determinants of health – and African American outmigration in San Francisco. 

Q: What have you put in place here to make sure that people who test positive get the care that they need or get connected to it? 

Dr. Kim Rhoads of UCSF – Photo: Marco Sanchez, UCSF

Dr. Kim Rhoads: This initiative has a “wraparound” piece that is largely driven and administered by community-based organizations, because the community-based organizations are on the ground all the time – whether there’s a pandemic or not. The initiative will have a clinical response team, who notify participants who have a positive test, and a community wellness team who serve the needs of those participants. 

When the clinical response team calls the participant to disclose the positive test result, they also ask whether or not the participant is able to isolate and quarantine, because a lot of these homes are going to have multigenerational families with a lot of people living in a small space. They will ask about changes in symptoms and if they have any resource needs in terms of PPE [personal protective equipment, such as masks], cleaning supplies and whether they have enough food. 

At the testing event, we will have care packages with masks, gloves, food and information.

Anyone with a positive test is given access to the community wellness team – and through a collaboration with the Human Rights Commission, the team will deliver food and PPE and supplies during the two weeks that we think it takes to clear this infection. Initially, people may be reluctant to admit they need help, but over time, in the Mission, we have heard that the participants start calling the hotline themselves and making specific requests like, “Can you pick me up some lemons?” 

Q: How are people reacting to the idea that they can get testing for themselves?

Dr. Monique LeSarre of Rafiki 

Dr. LeSarre: It’s just like any community; there’s a whole range of reactions. At the testing event, we will have care packages with masks, gloves, food and information. We are going to offer nasal swabs, which test whether people have active infections, and also the opportunity to have a blood draw to see if they have antibodies to the virus. This will tell you if you’ve already had an infection and have recovered from it.

Some folks really want to know all of that. And some folks don’t. They can come and get the box and they don’t have to get anything else. But we’d like folks to get tested if they want. 

Q: How can this help contain the virus?

Dr. Rhoads: Since we don’t have any treatment and we don’t have prevention for this virus, really the only way to crush it is to try to identify people who are positive and are potentially infectious and to provide whatever support they need to isolate. We’re saying, OK, as a community, we need you not to circulate. It’s not personal. But in order to eradicate this virus, we need you to isolate or quarantine. And we’re going to provide the resources you need to be able to stay home. 

Q: And that includes helping people with their rent? 

Dr. LeSarre: Yes, the Board of Supervisors just passed the “Right to Recover,” which was sponsored by Supervisor Hillary Ronen, based on the findings from UCSF’s study in the Mission, which found it was the essential workers who couldn’t afford to stay home who were getting infected. Most of them didn’t have paid time off, and they needed financial support in order to be able to stay home for two weeks while they got over the infection.

Q: What do you expect to learn from this testing initiative?

Dr. Rhoads: It’s unclear to me how you can open safely if you don’t have an intervention like this in place. It’s critically important to understand what the distribution of COVID-19 is in places like the Mission, the Bayview, Sunnydale and Vis Valley, which is where a lot of our so-called essential workers live. They are the ones who are most likely to be forced back to work first. If the infection rate is actually higher than we thought, then we need to think again about how we open safely.

If nothing else, this virus is asking us to understand two critical things. One is how connected we all are to each other. My carrying the virus is a danger to everyone else around, not just to myself. And then the second thing it’s showing us is the importance of public health. 

Dr. LeSarre: Think about the people you love. Think about your auntie. Think about your grandmother.

United in Health D10 is part of the recently launched UCSF COVID-19 Community Public Health Initiative, which aims to counteract an overall lack of data about the community spread of the novel coronavirus that has made the virus hard to track and contain. The initiative recently sponsored a similar testing program in the Mission District, an area that, along with the neighborhoods in United in Health D10, is among the neighborhoods with the highest rate of coronavirus cases in San Francisco. 

Although many people who become infected with the coronavirus may never show symptoms, they can still spread the illness. And even those who do experience symptoms may never get sick enough to go to the hospital, and also may not get tested. 

With a goal of reaching 800 individuals per day over a four-day period, both diagnostic (PCR) and serological (“antibody”) tests will be offered to “all who live, work, play or pray in these diverse, multigenerational neighborhoods,” said Michelle Pierce, MBA, executive director of the Bayview Hunters Point Community Advocates, who has worked closely with Rhoads to engage families and community organizations in the new testing program. 

Michelle Pierce of Bayview Hunters Point Community Advocates

United in Health D10 also benefited from the enthusiastic backing of District 10 Supervisor Shamann Walton, who represents the neighborhoods where the testing will take place. “I’m proud to work with UCSF and District 10 community leaders to bring COVID-19 testing to the Bayview, Sunnydale and Visitacion Valley,” Walton said. “Like UCSF’s prior study in the Mission, this testing program in D10 will help us to better understand the spread of COVID-19 in San Francisco’s most vulnerable neighborhoods.” 

And as with the Mission District study, United in Health D10 takes advantage of greatly increased capacity for COVID-19 sample analysis now available at a new UCSF diagnostic laboratory adjacent to CZ Biohub at Mission Bay. That lab, built from scratch in just eight days in March, is now providing free COVID-19 test results to all 58 county departments of public health in California.

“This program will provide voluntary testing to populations and locations in our city that are most affected by health disparities, by income inequality and by structural racism.”

The diagnostic test for COVID-19 is not perfect, and it also is just a snapshot in time, so those who test negative will be advised to continue to abide by shelter-in-place and social-distancing mandates to protect them from getting infected or infecting others. 

“UCSF has been a key partner of the San Francisco Department of Public Health, and together we are doing everything we can to support the health for all our communities in our city,” said Grant Colfax, MD, MPH, director of health for SFDPH. “This program will provide voluntary testing to populations and locations in our city that are most affected by health disparities, by income inequality and by structural racism. 

“Moreover, this testing effort will help identify and slow the spread of COVID-19 in the community and help provide critical information to the community, scientists and public health agencies about how the disease spreads and how we can stop it.” 

UCSF Professor of Medicine Diane Havlir, MD, the scientific lead of United in Health D10, emphasized that testing is foundational to every other component of the pandemic response that UCSF has mounted in collaboration with the State of California and the City and County of San Francisco, especially as the state and City move to reopen businesses and places of worship. 

“This is what we must do in order for us to respond effectively and reopen safely,” said Dr. Havlir, chief of the Division of HIV, Infectious Diseases and Global Medicine at Zuckerberg San Francisco General Hospital and Trauma Center. “We need more local community epidemiology like this to get a sense of where we stand, and where active infection may still be occurring, so as public health officials begin to release constraints on movements, we can avoid resurgence of the disease.”  

In addition to the efforts cited above, UCSF’s closely coordinated response with the City and County of San Francisco and state of California to COVID-19 has included providing forecasting and counseling by UCSF epidemiologists; implementing a statewide contact tracing program in collaboration with the California Department of Health; providing $1 million and clinical expertise for the City to open a COVID19 unit at Saint Francis Memorial Hospital; and opening a new, 53-bed respiratory isolation unit at UCSF Health’s Mount Zion hospital to expand the city’s overall hospital capacity for potential future surges, while offering dedicated space for current patients. 

The proactive effort builds on UCSF’s long-standing commitment to addressing public health crises, which dates back to the university’s founding in the mid-19th century and includes such issues as homelessness, and such diseases as cholera, tuberculosis and HIV/AIDS. 

More information is available on United in Health’s website, https://unitedinhealth.org/.